The Tension Between “Margin and Mission” as an Ethical Issue in Healthcare

Abstract

It is non-controversial that clinical ethics issues frequently arise due to wider structural or organizational ethics issues. A clinical ethics consultant may play an important role in identifying these systemic issues and assisting their organizations as they reflect upon and initiate organizational practices to better reflect their professed ethical commitments. Less clear is the role of the ethics consultant in what might be described as “the business of healthcare,” i.e., business decisions that seem distant from the bedside and the core competencies of the ethics consultant. This case study examines a dilemma between a proposed business venture of a not-for-profit health system that might negatively impact a community asset that promotes a social determinant of health. The case demonstrates how the core competencies of healthcare ethics consultation can be utilized in the setting of business ethics to facilitate the resolution of an ethical dilemma and promote ethics education and leadership development to avoid and address such issues in the future.